TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
CLIENT: Good morning.
THERAPIST: Morning.
CLIENT: So I'm not exactly sure, oh I've got a check for you, (inaudible).
THERAPIST: Oh, thank you.
CLIENT: Sorry.
THERAPIST: Thank you.
CLIENT: So I'm not exactly sure about what to talk about today, but I guess I have four general categories that are fanatic, or something, but how do people live with depressed partners? What are our obligations in relationships, both like that and more generally? I have more, but, oh, why am I angry, and what do what do I do about it?
But I think there was one more, but it's gone now. They're out of order, don't know what it was. I don't really know. Nothing is pressing in the sense that I must talk about it this week, so whatever strikes your fancy, I'm happy to go down that path. [00:01:15]
Are you going to leave me to decide?
THERAPIST: Yeah. Because they all seem interesting, so I'm going to see where you go with it.
CLIENT: It's a question of how do people live with depressed partners? I don't know that I have any answer, we'll just do and then people don't. Several of my good friends have dated or been engaged to people who had some sort of depression or anxiety disorder or somewhere in the spectrum of both, and all of those relationships have ended, so after years in, well a year in one case, and years in the other case, but so it's kind of like it works for awhile, and then doesn't. That's all I have on that subject, because I don't have the answers, it was a question. [00:02:48]
THERAPIST: Well certainly that your personal statistic has some meaning for you.
CLIENT: The largest meaning it has is I don't know how to take it. They're both good friends, and I like both of them a whole lot, and I respect both of them and so I have as much confidence as I can have they did the right thing for themselves, and I'm not sure that there's much more to say than that other than like what's right for them is not necessarily applicable to my situation at all. [00:04:00]
I think in my view, have not made the same commitments that I've made, so it's more like these are the only observations I have. It's not very helpful in answering the question of how do people live or deal with it? Because the answer is, ultimately, they don't.
(pause) So I'm having to move on to why am I angry and what do I do about it, or what can I do about it? [00:05:04]
Why is a hard question to answer there, but it certainly seems to have been most frequently in cases where I think you had put it where I don't have control, or feel like I don't have control, which isn't, in some ways isn't fine-grained enough. Because it's not every circumstance in which I feel like I don't have control, that I am angry. A piece is often, I think, feeling like there's some violation of an agreement or obvious contract or something like that. So I just (inaudible) not managed to process anything from like late November, and I keep processing and pretending that Tanya hasn't paid her deductible which she paid by the end of September, and then blaming our computers. [00:06:11]
None of those matter, it's like no, it's very simple. You have a legal obligation, you have a contractual obligation with Tanya, now you, obviously, they. Having a moral obligation to fulfill their contractual obligations. And they're not meeting any of those, and they're diffusing it across some phone answering persons, and this makes me very angry. And certainly not having control over a piece of that. I can't make them do it, and that's exacerbated by Tanya being the one who's on the phone with them. But I think part of it also lies in this like sense of extreme wrong that's A, putting us in a very tough financial position, and B, as a result of that putting us in a tough position in terms of Tanya's psyche, and C, if they're doing it to us, they have to be doing it to basically everyone else that they're dealing with right now. [00:07:12]
And that's incredibly wrong, so it's like magnify what they're doing to us and add some coefficient to scale it to everybody else, then multiply it by, some several million customers, I think, because I think they're the largest provider in Colorado, and great Denver area has five plus million people, so it's got to be in the millions. So like, and yeah, continue to be rated as one of the best. What does that say about our healthcare system?
So, (pause)... and all that's complicated by I think I have a very different take on personal and contractual and social obligations from most people. [00:07:12]
Talking to my friend Franco who pays his taxes appropriately, but most of his colleagues at Brown, because Brown refuses to get involved in paying fair withholding on the scholarships, many students interpret this as they don't have to pay taxes on it, which in the wording is very clear. The scholarships are tax-exempt when they are used to pay for certain, I can't quote it, I'm not a lawyer, but certain allowed expenses or something like that. [00:09:01]
Which include tuition, fees, books, supplies necessary for school, period. (inaudible), most explanations go on to say this does not include other expenses such as room and board. And so the obligations then are very, very clear, right? We have a legal obligation to pay these, and it's not a matter of like if they never chase you down, you didn't have to pay it. No, you just have an obligation to pay that. Part of being a citizen is paying your taxes, whether you like them or not.
So I wouldn't say I'm particularly angry with those people, and sometimes I can understand their position, like when it's done out of ignorance, your first year when no one's mentioned it and you don't ever get a W-2 and it's not really clear what you're supposed to do. Well, confusion is perfectly excusable. [00:10:09]
But like willful not paying it and then giving a defense that's not how I interpreted it, that's confusing to me. I don't understand how someone could look at the same language that I've looked at and be confused at all. It's only like you either haven't looked at it, or you've looked at it and decided the factually wrong thing.
THERAPIST: Well, they don't want to pay their taxes. That's why they're doing it.
CLIENT: Yeah, but I don't want to pay the taxes either, right? I would rather I would have the money than the federal government have it because they're pretty ineffective at spending money in a useful fashion. They're just inefficient at everything they do, even if they're aiming at the right things. [00:11:08]
Except apparently Medicare. Medicare is apparently like much more efficient than the rest of the healthcare system, according to what I read most recently. I'm not sure if that's true or not, but interesting at least.
THERAPIST: So that is an interesting question, because they don't want to pay their taxes, you don't want to pay your taxes, and yet you do and not all of them are within that system, so then the question is, what's the difference? I guess that's what you're asking or pointing out.
CLIENT: Yeah, something like that, yeah. You know, again, it's very clear to me that there are certain legal obligations and that we have moral obligations to meet our legal obligations, except under certain circumstances like conscientious objection. [00:12:00]
You know, if the law is, the law violates some clear higher norm, fine. What we have, we have practicing moral obligation to violate the law at that point, but I never heard anyone make any argument that paying taxes violates a clear higher norm.
THERAPIST: Libertarians might, Libertarians might.
CLIENT: Sure. As might anarchists in the light, not blowing things up since because I mean, they fall in the same spectrum at that point. But, but I really think that what that person has to be arguing at that point is that the system that we have is not the right system. [00:12:59]
And I would have thought the burden is now on them to make some case for non-payment of taxes being a useful or reasonable protest to the system, and I still fail to see that, but even leaving those people aside, those are not the people who are not paying their taxes by and large, they're just people who are in a similar situation to me who just say, "No, I'm going to ..." Whatever social contract we have is just not that important.
I think I sound pretty upset about that, but I actually don't care very much about just like. I feel like this is something about which I don't care very much, but it's also representative of a class of problem or something like that, so it's interesting and easier to talk about or something. [00:14:02]
One that's obviously trivial is like crossing the street. So people in Denver and Andover are very bad at following any sort of traffic markings or regulations or most crosswalks or most intersections have crosswalks, and when they don't, there's probably a good reason for it. These things are selected at specific places. Crosswalks for traffic flow becomes high for pedestrian and cars have, you know, electronic signals that control traffic in the same way traffic signals do, so-called stoplights. [00:14:57]
It's very simple, yet jaywalking into traffic is one of the most common sights in pedestrian traffic in the area. Beyond the like personal safety issue of you're really trusting that someone doesn't want to hit you or is paying enough attention really to not hit you. I'm not sure that second part is true, since like 50 percent of adults admit to texting while driving, even though they know it's wrong and dangerous. Beyond that, there's a sort of, and beyond like moral and vehicle obligations, there's just an efficiency perspective from it, so if one is driving in the car, someone crossing in front of you, really impedes your traffic flow. If one's walking and a car cuts in front of you, perhaps hitting you or almost hitting you, that's really not a good day for you either. [00:16:11]
So the two have to interact in some way, share a fairly intimately connected system, so a very safe societal construct to deal with that. That's traffic regulation. Now if no cars are coming, walking across the street is it's not a thing, because you're not interfering with anyone else, but I feel like the moment where you start to interfere with other people, you're crossing an efficiency line. I think that has moral consequences, because you're then prioritizing what you want over what other people want in a way that I don't think I find acceptable. [00:17:13]
THERAPIST: But that's a big problem, because there's a lot of things we've talked about that are unacceptable, and then what do you do about them? Which is maybe the anger part. What do you do with the feelings?
CLIENT: (pause) So far, for crossing the streets, the only answer I have is I try not to hold onto any anger that gets generated in the moment and to cross the streets the way I think is appropriate. You know, if I think there's a clear sort of system-optimal thing to do, I should do that. [00:18:14]
And if I think in this case it does align mostly with the legal obligations of crossing the street, so just do both of those. And in fat, if everyone reasoned in a similar fashion, things would work in a system-optimal fashion. So that's, that's how it's like. But I can't make everyone else (inaudible) in the system-optimal fashion. I can't make that be something everyone else considers, whether it should be or not. [00:18:59]
So when I'm walking with other people, most of the time I just walk the way I normally would which is confusing to a lot of people because they just, "Why would you stop at the crosswalk and check for traffic and then wait until your legally allowed to go and or it's safe?" But that has sort of behavior propagates in some way. And then people are aware enough of their legal obligations that occasionally walking, you know at the same time as people I don't know if I stop, everyone else stops, or some portion of them stop, because people have a sort of tendency to follow whatever the crowd around them is doing. So those are things. [00:19:59]
In the case of taxes, my friend Franco said, "Well, you know, the wording doesn't seem to be that clear," so while I was going through reading the Colorado wording about things that are much less clear than that, trying to make sure I filled out all of the correct forms, I found a very nice discussion on a Colorado site that says almost exactly what I just said to you in a paragraph, so I sent it to him as a, well, here's a place where it seems very clear. And so there the answer is like for the people who are claiming that clarity is the problem, provided some clarity.
THERAPIST: Yeah, but of course that's not the problem. I mean, of course that's an excuse for, "I don't want to do this." [00:21:04]
I mean, if there's not something unclear to you that's really important to clarify, you'll go seek the information and clarify it. People are either saying it's unclear or it's not, or it's unclear but they're not motivated to clarify it, they're motivated to make the decision that it's in their best interest or immediate interest.
CLIENT: Yeah, so in that second case, what happens if you take away the lack of clarity.
THERAPIST: Then they have a choice as to whether they do what seems the right thing to do from a social contractual point of view, or do what they want to do that serves their own personal interest.
CLIENT: Right. So basically, I have to make that choice explicit.
THERAPIST: Yeah. I mean, I make less a distinction between implicit and explicit choices, not seeking out information to make a choice is making a choice. I don't make as big a distinction. [00:22:11]
CLIENT: OK. I'm not sure exactly how to scale that up, because we can't seek out all the information to make every decision.
THERAPIST: That's true. The example you gave is so circumscribed, though.
CLIENT: OK, OK. I wasn't sure if you were trying to make a more general claim or not.
THERAPIST: It'd be interesting to try to scale out, it's interesting in itself whether you can make more general claims. That's interesting, I hadn't thought of that at that point. [00:22:57]
CLIENT: It certainly becomes a problem, so I think that when most students are deciding where to go to school, they do not have and cannot have enough information to make the actually optimal decision. I think because the time scale of school is so long, that they can make the best decision for the moment, but it's really hard to make the best decision for them across five or eight years. And so, but I don't think (inaudible) would say they're willfully making the wrong choice or something like that.
THERAPIST: I mean, the decision for school, judging what would be best for them or what would be the best?
CLIENT: Yeah, so given a set of schools that one could attend, which one is the best one to attend?
THERAPIST: There's just too many, right? They are (inaudible). That seems like so many variables. [00:24:02]
CLIENT: Right.
THERAPIST: Do you feel like when people like, they know they should pay this tax, but they just don't, does it is it hard to understand? Like is it just, "how could you possibly do that?" Is it, what's it feel like, or what's the thought?
CLIENT: Yeah, yeah, no, the feeling's something like so there was the confusion which I think you've clarified, because they just don't want to. How could you not read this tax and understand it? Like these are presumably bright people, they're Brown graduate students that, the language is very simple. It's not like some of the tax code, and it's actually like an explanation of the tax code, so it's so there's the confusion like ... I mean, I remember being confused about what I was supposed to do about scholarships and fellowships, so it's not confusion about it that's difficult, it's the like failing to find a clear answer. [00:25:06]
It's hard to see how that would happen. If you're confused, find an answer. And then yeah, it's like when they give the excuse, "well, that's not how I read it," (pause). Yeah, this confusion is like, are we reading the same thing? Did I have I missed something here? [00:25:57]
And if I haven't, what? What, where do I stand? And so I guess you're saying that, "Well, they just don't want to do it." And, but, even that I don't really understand.
THERAPIST: Well that's what I was asking, is that piece.
CLIENT: See, I guess what I'm trying to say is that I so don't understand that that I keep looking for something else, and then I'm more confused. OK, I don't understand, I think, the idea of this is what I ought to do, I'm just not going to do it because I don't want to. Except under specific circumstances, so I understand that so the essence of depression is a lack of the necessary will to do what one ought to do. [00:27:07]
Doing things takes some effort, at least I find it usually does, and so I feel like depression in a lot of ways is just a lack of the will to do things at all, which translates into, like, if I really don't want to do something, I just can't do it, or feel like I can't do it I think is probably more appropriate. Yeah, it's outside that context and I don't know if I understand it at all. It's just hard to grasp. [00:28:04]
So sort of like you had to know that was going to be the answer.
THERAPIST: Really?
CLIENT: Maybe not had to know, I think that felt sort of like it was a question leading to that answer, that's a more accurate (inaudible). You were really just curious.
THERAPIST: No, I actually, I wasn't actually, yeah, I was curious. I wasn't sure how you would think about it. Did it seem like it should be more obvious to me?
CLIENT: Not in any essential sense, only in the sense of like I thought that from the specific question you chose, I thought you had a specific reading of me that would make that the answer. [00:29:15]
Does that makes sense? Like, by picking that question to ask there, but then I can see that that's not necessarily the case, I could just see that that's the right question to ask, not know what the answer is.
THERAPIST: Yeah, I mean one thing I was seeing as a sort of a thought, I mean I think that's especially important as a follow-up, is sort of like when I said, when you were talking about, you know, in terms of training students and feeling sort of morally challenged by that, you know, given the options they have that, and I just lost my train of thought going to that. That a lot of people's behavior will be confusing and kind of frustrating, because lots of people don't, you know, ignore rules and regulations and do what they want. So I would imagine that life's throwing you lot of a series of frustrations on that matter. It happens all the time. [00:30:03]
CLIENT: It really does, yeah. I don't really know, really know what to do about it.
THERAPIST: I can see that. No, I mean, this is important.
CLIENT: Yeah, well I think it's important, but clearly not everyone does, right? But maybe you meant like it's important to me, how I deal with it.
THERAPIST: It's important how you deal with it, how you're taking it in and dealing with it. Do you feel like your family very much lives by this, like in terms of the guiding principles should always be what you ought to do?
CLIENT: I think so. Yeah, I feel like I read books sometimes where the families have very clear guiding principles, and they're talked about explicitly. I don't feel like there's any big talk. of we ought to do this because it's the right thing to do. It's just kind of much more (inaudible). [00:31:17]
Outlook on life, that a motto or something, if that. Was that clear at all? OK. So it's not like I feel like it's this common discussion of it in that language, but I was talking with my mother this morning because my parents are going to come visit us at some point, and we're trying to figure out when they're going to come visit. [00:32:10]
And it's turned into a complicated optimizing mess because one of my friends is having a baby shower for his and his wife's first child, and so we want to, Tanya and I want to go to that, but sort of ask the question of him of whether it would be better for us to come to that, or come visit him and his wife like later in the pregnancy, just visit with them and take care of them or whatever in that time. And he said yeah, I'll get back to you, just let me talk to her, and then I haven't heard from him in four days, so while my parents pick which weekend they're coming and the flights. [00:33:00]
So I was talking with my mother today and I talked with my dad I guess two days ago. I was talking with my mother, and she says, "Your dad is very funny. He's hyper about this and it's just like keeps second and third and fourth-guessing himself, so I just thought I would call you and say, 'What's going to be best?'" And so in a situation where all three of us now are trying to pick what the optimal thing is to do, and I haven't got a clue what the optimal thing is to do, just for them to come visit, just come visit, it's OK.
But they're trying to like, you know, if I were to try to graduate in August, I have to defend by June 28th, so my dad doesn't want to get in the way of that, even though I've told him my order of priorities is, you all come visit, I'll figure out where the thesis goes, the margin of error in getting it done, it's plus or minus a week or something. [00:33:58]
And if you visit for three days, it's all in the error anyways, it doesn't matter. But they're still trying to figure out what the best thing to do is. And it's not just surrounding me, because they have other children and my youngest brother is a junior in high school and so they have to take care of him and if they both come visit he has to stay with someone, and it goes on from there.
I think it was just funny for me in light of my perception from talking with you that not all people make decisions in this fashion, that my father makes decisions very, very, similarly to the way I do, and maybe that's the wrong order to express that similarity in. I'm there was a reason I was saying all of that in light of what you'd said, but I can't remember what it was. I talked for too long.
THERAPIST: No you didn't. [00:35:03]
CLIENT: Well I talked (inaudible) remember why I started. But I think it had to do with how my family approaches the world.
THERAPIST: Yeah. I mean, I, yeah, I guess one question is that I was thinking like, what does it mean that people do things that they want to do versus the right thing? Like what happens, or what ...
CLIENT: Traffic jams happen. I'm sorry, it was sort of a ...
THERAPIST: No, that's a good (inaudible).
CLIENT: I mean, the way to get out of traffic jams is to, like the system-optimal way, as far as I can tell, is to open up following distance and speed up only slowly coming out of a traffic jam. Because the most frequent thing I see happen is lanes contract, it's a traffic jam because two-way cars go too fast, too little space. [00:35:59]
They come, they get through it finally, and then they speed as close back up to the full speed as they can get in as little time as possible (inaudible) so now you're back to two cars too fast (inaudible) road. And so the thing is to slow down going into the narrowing so that the too fast, too many cars, too little space doesn't happen. Anyway, when it does happen anyway, there's a little bit of space between cars to eat up, and then coming back out, do the same thing. Anyway ...
That's the system-optimal thing. It turns out it's not clear to most people that that's actually the most system-optimal thing, but it is. By doing it in a car, it eventually, people get frustrated and like swerve around you, which is not great, but very, very few people do that. Most people just are confused enough that they open up their following distance behind you to a considerable extent. [00:37:01]
Which that has the effect of starting to solve the problem. Because people really want is to not be in the traffic jam because they want to get where they're going. I don't know how to answer the question, what does it mean when people do what they want instead of what they ought to do? Sometimes it doesn't matter, but within an interaction with other people, it probably (inaudible). You are asserting your need (inaudible) to power over other people in a way that ... in a way that often gets valued, but I'm not sure is valuable. [00:38:02]
THERAPIST: There's (inaudible) non sequitur, but I don't think it is. But the more I bring it up, and I'm bringing it up now for me because I think it follows. You know, you could ask me to pay, you can ask to pay me when you start getting reimbursed, you know that? You could, as an option.
CLIENT: Well, thank you.
THERAPIST: But maybe that's, but actually, that's, when I say it's an option, maybe that's something that we talk about, should talk about too, because maybe it doesn't feel like an option. [00:39:01]
CLIENT: Well, it's complicated in a lot of ways. I'm not really sure which way to approach it. (pause) Yeah, maybe I should just start, let's take that, so in one way, we have a very strange relationship that is complicated for me already, because what we sort of have conversations, like we talk, but there's a clear limit to like, or I assume there's a limit that I'm not supposed to cross. [00:40:16]
Like I'm not supposed to ask you questions about you seems to be the norm, not that you've put that in place, but that's what I've (inaudible).
THERAPIST: (inaudible) put that into place, but ...
CLIENT: Yeah, no, I don't think you have. But that's because I think there is a norm there. That is what I have that is my understanding from other people who have therapeutic relationships, and so I have attempted not to violate that norm without making you (inaudible). That's because that if I know the norm is there, then I don't need you to say it. Does that make sense? Now, if it turns out that that norm is not there for you, then that is its own complicating thing, and then I have made a mistake in aiming for some sort of optimality. [00:41:10]
But so we have this relationship that I at least feel like is somewhat bounded, certainly. It's (inaudible), and it's spatially bounded. It's here, and it's at this time. And Eve, you reiterate that I'm not supposed to take care of you, like I'm not supposed to worry about that. That's ... I do as well as I can, but the one way I get to take care of you is by paying you because that's the those are the terms that which we're working, so can I not? I don't know, that's one level. [00:41:59]
Another level is, I don't know. So Chad switched from being me, in-network to out-of-network provider for healthcare, and he, which means that now Tanya has to, or Tanya and I have to pay him a large sum of money that he, in theory, was getting directly from the health insurance before, and then be reimbursed by the health insurance as I've mentioned, not very good at being timely right now. And so I don't know what conversations happen between them, and I know Tanya has some similar susceptibility or viewpoints to mine on the subject of like taking care of people and following norms. [00:43:02]
So for, but then it's all complicated by Tanya not being able to remember anything from January or most of February, so I don't know what conversations have actually happened between them. You get, my understanding was that was OK for awhile to wait until the health insurance company had started sending money, but then he finally just asked her to pay it, so we put the sums on credit cards and are still waiting for the health insurance company to reimburse us, so that's another way it's complicated.
THERAPIST: How is that, so that's, well that's just sort of (inaudible) actually have more financial burden it looks like, and how is that piece complicated for us?
CLIENT: Oh, because I assume that there are sort of like system-wide norms for therapeutic relationships, and so ... [00:44:15]
THERAPIST: I wonder if it's safer. I was thinking about this, a thought that came to my mind is I wonder if in some ways it's limiting, but safer that way, rather to think of (inaudible) each therapist as their own, sort of (inaudible) entity, then there's some, certainly we just don't do whatever the hell we want, but that we serve our own norms and values and so forth, and we each practice very differently, and, you know, have different ways of thinking, you know, differences about, you know, that somehow that that I mean in some ways, on the one side that I imagine can be very freeing, but on the other side maybe even scarier that there's so much variability.
CLIENT: Well, certainly you remember I was reluctant to find a different therapist. [00:45:12]
So I think, at least on some level, I know that there are differences. It's a challenging question, because my first response is kind of, well, yeah, there's probably some safety in that, but I don't think that's why I'm doing it, but that's the answer I'm not really sure whether that's the answer or not, if that makes sense.
Part of what's going on is like I've used my observations of other peoples' relationships in general to make, at least guesses about other relationships, if that makes sense. It's just like Tanya has a therapist, Neal has a therapist, like the relationships have certain dynamics. [00:46:16]
And while I understand they're different, there are some like categorical similarity to them. There are licensure requirements, so there are some categorical ... so I don't know.
THERAPIST: Yeah, there's something about the assumptions that are, they are preferring or (inaudible) with assumptions, rather than asking or talking about it. And it very much relates to this issue of obligations. [00:47:05]
And in a sense we're in front of the tax perspective, the obligations are clear and are coming from the government. But then there's a ways in which I wonder, your set of how you feel obligated, where those obligations are coming from? You know, in terms of assuming you were having obligations to me that I may not feel you're obliged to me for, and so there's this obligations, well they seem inherent to the system and so the relationship may be coming currently from you. And I sort of wonder how that impacts other things for you? That's where I was going with that.
You know, I realize we do need to stop. I do want to talk specifically, though, I mean, I have I very much in general, though. First, I asked to be paid by the following month with the assumption that it usually takes a month to get reimbursed. That's not why, usually a couple weeks. But I really try to be flexible with people who are having a hard time getting reimbursed, especially since it's been for several months. [00:47:59]
Well we can talk about something. You know, it saddens me to hear how, you know, strained you are because of the situation. The other thing is, you know, I can't guarantee that this will be useful at all, but I'm happy to call the health insurance company. I have an assistant who helps with the billing. She e-mails you, Ms. Johnson (ph), and I'm happy to have her see if she can call too. Again, I can't guarantee anything, but it could help.
CLIENT: I appreciate that offer. I don't. So the health insurance company keeps misprocessing it and then Tanya will call and they'll misprocess it again, so I don't know whether it's better or worse to add more people to the calling the health insurance company, so like, you know, they ...
THERAPIST: It's up to you. I'm not going to do anything at this point, but it's never worse. It may not be better, but adding more, it's not like another problem-solving where you don't want too many chefs in the kitchen. Insurance doesn't work that way. It's a matter of, simply a matter of force that if there's enough forces, sometimes, it's not an it's not as sophisticated as people being orchestrated or working together. [00:49:00]
That's my experience, but not to say that it will help, but it usually doesn't hurt.
CLIENT: Thanks. I will think about it and let you know.
THERAPIST: OK.
CLIENT: Thanks.
THERAPIST: I have some time set, block. I will see you next week. Take care.
CLIENT: You too. [00:49:22]
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